{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:55:21Z","timestamp":1792025721875,"version":"4.4.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T00:00:00Z","timestamp":1469145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Clinical Ultrasound"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right\u2010to\u2010left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end\u2010expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre\u2010 and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high\u2010PEEP ventilation induced a paradoxical response with life\u2010threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva\/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. \u00a9 2016 Wiley Periodicals, Inc. <jats:italic>J Clin Ultrasound<\/jats:italic> <jats:bold>45<\/jats:bold>:58\u201361, 2017<\/jats:p>","DOI":"10.1002\/jcu.22383","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T06:26:49Z","timestamp":1469168809000},"page":"58-61","source":"Crossref","is-referenced-by-count":9,"title":["Patent foramen ovale diagnosis: The importance of provocative maneuvers"],"prefix":"10.1002","volume":"45","author":[{"given":"Silvia","family":"Mongodi","sequence":"first","affiliation":[{"name":"Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo University of Pavia Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Via","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. 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